A Randomized Double-Blind Comparison of IV Ibuprofen vs. IV Ketorolac to Prevent Postoperative Pain after Scheduled Cesarean Section
Veronica Mahon DO, Dmitri Chamchad MD, Jay C Horrow MD MS FACC, Andrew Gerson MD, Norman Brest MD

Introduction: Intravenous ibuprofen may offer advantages over ketorolac for postoperative pain control, perioperative bleeding, and secretion into breast milk. This study examined analgesia after Cesarean section and perioperative Cesarean section bleeding, comparing intravenous ibuprofen to intravenous ketorolac. Methods: Forty-eight patients received in randomized, double-blinded fashion, 4 doses of either IV ibuprofen or IV ketorolac every 6 hours beginning just after scheduled primary or repeat Cesarean section conducted with bupivacaine spinal anesthesia. Rescue, on demand hydromorphone via a patient controlled analgesia pump measured unmet analgesic need. Drop in serum hemoglobin concentration assessed clinically relevant bleeding. Results: The demographically similar groups (33±4.8 [SD] years old; 64±2.7 inches tall; 92±20.8 kg weight) did not differ in perioperative fluid administration or operative time. The numbers of hydromorphone doses requested did not differ (5.04  6.49 [median 3] for ketorolac; 7.92  10.43 [4] for ibuprofen; P= 0.56) nor did those delivered (4.30  4.85 [3] vs. 6.96  9.17 [4] respectively; P=0.59). No patient received a transfusion. Perioperative decrease in hemoglobin concentration did not differ (1.99  0.66 [2.0] ketorolac vs. 2.26  0.91 [2.1] ibuprofen, P=0.35). Discussion: IV ibuprofen appears to offer no analgesic or bleeding-related benefit over IV ketorolac in patients undergoing scheduled primary or repeat C esarean section.

Full Text: PDF     DOI: 10.15640/ijhs.v4n3a1